What Is An “Exacerbation” Of Congestive Heart Failure (CHF)?

An exacerbation of CHF is a sudden and prolonged worsening of a patient’s CHF symptoms, such as an in-creased shortness of breath, mental confusion, leg swelling, fatigue, and weight gain. In severe cases, an exacerbation of CHF can be complicated by extreme shortness of breath. The patient even may report a feeling of drowning. The patient may cough up pink frothy sputum or may even become confused or unconscious.

A CHF exacerbation is a medical emergency and re-quires the immediate attention of a doctor. Exacerbations of CHF occur when there is an in-creased demand placed on the heart that the weakened heart cannot compensate for by beating harder or faster. These increased demands may be the result of cardiac or noncardiac changes. These exacerbations often are life threatening and can lead to hospitalization. The number of CHF exacerbations per year and the severity of exacerbations can increase as the disease progresses and the heart becomes less able to handle increased loads. Heart failure exacerbations are very common reasons for hospitalization in the United States and Canada. In severe cases, the patient needs the mechanical  support of a  ventilator until the acute symptoms  have resolved.

In a study examining factors that lead to worsening CHF, nearly one third of incidents occurred because of patients’ failure to comply with a medical regimen. For example, about 22 percent of patients did not restrict their intake of salt. Salt promotes the retention of water in the bloodstream, which can place an added strain on an already weakened heart. Eventually, excess water can back up into the lungs. Another 7 percent did not com-ply with instructions for taking their medication. In fact, many in this group stopped taking their medications altogether.

Some other causes of CHF exacerbation are:

  • Excessive alcohol intake
  • Lung infections
  • Increased exercise
  • Irregular heartbeats (both beats that are too fast and too slow)
  • Coronary artery disease
  • Side effects of medications (especially the use  of negative inotropic drugs such as beta-blockers, disopyramide, verapamil, nifedipine, diltiazem)
  • Increased high blood pressure
  • Heart valve infections (endocarditis)
  • Anemia

Although this information may be frightening or even depressing, there is good news here. The most common causes of CHF exacerbation are within the control of the average patient. By attending to these factors, physicians and patients can help to prevent the commonest causes of CHF exacerbation. Managing these causes not only deals with the immediate decompensation, but also improves the prognosis for the future.

Victoria’s comment: In the first year after my diagnosis, I had several exacerbations of my CHF. I was hospitalized for each one. Eventually, I underwent a coronary artery bypass surgery and really watched how much I exercised and how much salt I cooked with. I haven’t had an exacerbation in 3 years.